HomeMy WebLinkAboutUntitled (2) ® r' e , MINNESOTA MOTOR VEHICLE REGISTRATION/CAB CARD
v veni ieervices This vehicle may have been issued a certificate of title. The
te
of title is the only document that can be used to transfer owner hip a If
there is a lien or loan associated with this vehicle, you must obtain a
lien release from the lien holder prior to transfer of ownership. If you
do not have the certificate of title, contact Driver and Vehicle Services
or a deputy registrar for procedures.
Please Keep For Your Records
See Reverse Side for Contact Information
CITY OF OAK PARK HEIGHTS
�I DY F0083414
14168 N 57TH ST BOX 2007
STILLWATER MN 55082-6409
I111111MUM III IIInIIIIIIII I attest by this transaction that this vehicle in insured while operated upon
the public roads as required by law. Proof of insurance will be carried in the vehicle.
165365 02/2006 99 FORD 1FDAF57S2XED33333
Lj Plate Expire Year/Make Vehicle ID Number $10.00 F08901471
Base/GVW Tax Title No. Prev.Plate Lien Sticker34 �365 !
Number
Jennifer Pinski
From: Andrew Kegley
Sent: Thursday, March 22, 2012 11:09 AM
To: Jennifer Pinski
Subject: Ford F550 Title
Jen,
The P.W. will be trading in the 1999 F550. We'll need the title on Friday.
Andy Kegley, Public Works Director
City of Oak Park Heights
651.439.4439—Office
651.775.5759 - Cell
•
1
I' D CI ry '/ %�� SALE DATE
' D � OAKBAR ' �"� I > T^� BUYER'S SIGNATU E(\ j
14168 N 57TH '----------
;8OX 2007
W �.— STREET ADDRESS � - � '
�' R STILLWWATER MN 55082-3007
�i
(S) CITY ZIP CODE
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��-ERTIFICATE OF TITLjE -4 ¢ ,-s j
\,N, �. " z � i TO.-A MOTA®R VEHICLE ,'�^ ,� L ,k'
"� T 1 ,' k a, ,„THIS TITLE IS PRIMA FACIE PROOF OF OWNERSHIP .,
�I
x ° jFy I ks g L 'KIK IN A SAFE PLACEANY ALTERATION OR ERASURE VOIDS THIS TITLE �n
- Thr = � �„
9 Z. IFDAF57s2xED33333 10 FORD 99
B 1181111811x.,-
VEHICLE IDENTIFICATION NUMBER ODOMETER MAKE YEAR TYPE
V
F0890L471 03/30/9'9 NEW 03/08/99 :
TITLE NUMBER DATE ISSUED NEW OR USED IF NEW,DATE OF FIRST SALE FOR CENTRAL OFFICE USE ONLY
r NO SECURITY INTERESTS OWNER DOS 00000
7.
CITY OF OAK PARK; ',.
14168 N 57TH ST 30X 2001
�3 STILLWATER MN 55082-3007 1
a
T 02 s36S
ASS NMENT BY SELLER RRANSFERO ,
FEDERAL AND MINNESOTA LAW REOUIHE THAT YOU STATE THE/�'1ILEAGE IN CONNECTJON WITH THE TF(AN ER OF OWNERSHIP MINNESOTA. W1( VIRES THAT YOU
MAKE DISCLOSURES ABOUT POLLUTION CONTROL EQUIPMENT/yAND DAMAGE TO THE VEHICLE.FAILURE TO,C �APLETE OR PROVIDING A EALSETATEMENT MAY RESULT
IN FINES AND/OR IMPRISONMENT.SOME EXEMPTIONS MAY APLY: ,
/ ODOMETER DISCLOSURE STATEMENT,I(WE)STATE THAT T 1 ODOMETER NOW DAMAGE DISCLOSURE STATEMENT.TO THE,L EST OF MY KNOWLEDGE THIS
1 ✓J,, READS (NO TENTHS)MILE ND TO THE BEST VEHICLE ❑"'HA$� ❑ HASNQT(CHECK ONE)SUSTAINED DAMAGE IN
I ,,
OF MY KNOWLEDGE THAT IT REFLECTS THE ACTUAL MILEA, OF THE VEHICLE EXCESS OF 70%ACTUAL¢ASH VALUE `��'� ,' ,
/X DESCRIBED HEREIN UNLESS ONE OF THE FOLLOWING STATE NTS IS CHECKED. i p N, ,
Q (1) I HEREBY CERTIFY TO THE BEST OF MY KNOWLEDGEHE ODOMETER POLLUTION SYSTEM DI CLOSURE STATEMENT.TO THE BEST OF MY KNOWLEDGE
THE POLLUTION CONT LSYSTEM ON THIS VEHICLE INCLUDING THE RESTRICTED
h = READING REFLECTS THE AMOUNT OF KNOWLEDGE CESS OF ITS - ��
MECHANICAL LIMITS, . r
� `� GASOLINE PIPE j/❑ HAS 0 HAS NOT(CHECK ONE),BEEN REMOVED,
0 (2) 1 HEREBY CERTIFY THAT THE ODOMETER READING:IS NOT €ACTUAL, ALTERED OR RENDERED INOPERATIVE. `E:
WARNING—ODOMETER DISCREPANCY IF BOX(1)OR(2)IS CHECKED, ASSa.iNMEbLT,-F(wE)CERTIFY THAT THIS VEHICLE IS FREE FROM ALL SECURITY ,, .,:
'' INTERESTS,WARRANT TITLE AND ASSIGN THE VEHICLE AND REGISTRATION PAID TO
7
SELLER'S PRINTED NAME DATE BUYER'S PRINTED NAME
SELLER'S STREET ADDRESS a
�” BUYER'S ADDRESS '
SELLER'S SIGNATURE ,, BUYER'S SIGNATURE ,
COMPLETE REVERSE SIDE APPLICATION FOR TITLE BY BUYER(TRANSFEREE) , .
'' PRINT BUYER'S FULL NAME(S)LAST,FIRST,AND MIDDLE k,.
r _ DATE(S)OF BIRTH 3
3 ,
n K STREET ADDRESS 1 CITY "
COUNTY STATE TIP CODE ,..',
i
', IS THIS VEHICLE SUBJECT TO SECURITY AGREEMENT(S)? NO 0 YES 0 ADDITIONAL 0''',.IF YES,COMPLETE SECTION BELOW '',
' FIRST SECURED PARTY(PRINT NAME)
DATE OF SECURITY AGREEMENT
,>+
STREET ADDRESS k - ',
CITY STAT€ 21P CODE 6.
. r,,,,,,,,,,,,,.", IF THERE IS AN ADDITIONAL _ NAME OF POLICYrS
SECURITYAGREEMENT(S) INSURANCE NUMBER x'
)'', COMPLETE AND ATTACH DPS2017. COMPANY
��' fix'
//J<'t,,,'''' I(we),certify I(we)am(are)of legal age,have bought this vehicle subject to liens shown and no others,this vehicle is and will continue to be insured while operating upon the :\,..,
. public streets and highways,and all of my(our)declarations are true and correct. ,
', IMPORTANT-PLEASE READ:PERSONAL INFORMATION CONTAINED IN YOUR MOTOR VEHICLE RECORD MAY BE DISCLOSED TO ANY PERSON WHO MAKES A REQUEST FOR IT THIS PERSONAL INFORMATION
n MAY ALSO BE USED,RENTED OR SOLD FOR USE IN SURVEYS,MARKETING,AND SOLICITATIONS.TO RESTRICT THESE USAGES PLEASE CHECK THE APPROPRIATE BOX(S)BELOW ' :
0 {/,,. DO NOT DISCLOSE MY INFORMATION TOANYONE NOTAUTHORIZED BY LAW. 0 DO NOT DISCLOSE MY INFORMATION FOR SURVEYS,MARKETING OR SOLICITATIONS. 0 -
vrf Y
BUYER'S SIGNATURE(S)ALL BUYERS SIGN. BUYER'S DRIVER LICENSE NUMBER(S)
. Y',K F( R ,1,,' 1 +.+`` -71.1 t �r i,tim k,,f, . .,;7''''� './,,-'''. , ,' ! ','; .L3'!i _ y' f' ,•. 9'`l ,. } \ ``
APPLICATION TO TITLE/REG. A VEHICLE PLATE NUMBER
YEAR FORVALKMTION.AND OFFICE USEONLY
FOR CENTRAL OFFICE USE ONLY .
...... )i (..T 5 6;
VAUDATION STICKER NUMBER vEW j',,..\ t
Z a''-,' ' 0 a e c MAI: 3 Y .
WEIGHT STICKER NUMBER
. .I-^1P l,`Wr1 4bl',
•,rAb ai i'' ry("?.!9 t'"
07
NON-NIOOTIASN REGISTRATION RECEIPT(CARD)AND CAD CARD
TITLE TRLE REG. REG TFR PREVIOUS PLATE NUMBER YEAR MONTH YEAR THIS COPY WHEN VALIDATED(STAMPED ON THE UPPER RI CORNER)BY
A & ONLY ONLY CHANGE EXPIRATION A DEPUTY REGISTRAR OR THE CENTRAL OFFICE WILL SERVE AS EVIDENCE OF
� J DATE TAX PAID FOR THE PERIOD INDICATED.THE REGISTRATION PLATES SHOWN ON
ill( V THIS RECEIPT HAVE BEEN ASSIGNED TO THE OWNER FOR USE ONLY ON THE
DATE OF PURCHASE CHECK NATURAL GAS VEHICLE DESCRIBED.
PURCHASER(S) �y gyp NEW j
USED FUEL IcAsaEE X OR PROPANE
OWNERS) March 08, 1999 TYPE DIESEL OTHER PLEASE CHECK IF THIS VEHICLE TRUCKS
RS: TRUCKS.OF AXLES
MUST HAS BEEN PREVIOUSLY EMPTY WEIGHT
BER
COMPLETE MODEL YEAR MAKE BODY/MODEL TYPE REGISTERED N MINNESOTA
vehicle ► 1999 FORD DUMPTRUCK
information VEHICLE IDENTIFICATION NUMBER ❑ Do not disclose my information to anyone not authorized by law.
1 FDAF57S2XED33333 Com BODY Ei ROOF a ❑ Do not disclose my information for surveys,marketing or solicitation.
PURCHASERS) ►LAST,FIRST.AND MIDDLE NAME DRIVERS UCENSE NO./DEALER NO. DATE OF BIRTH
OWNER(S)
informationCITY OF OAK PARK HEIGHTS
ADDITIONAL PURCHASER(S)OWNER(S)LAST,FIRST,AND MIDDLE NAME(S) DRIVERS LICENSE NO. DATE OF BIRTH(S)
I I
STREET ADDRESS CITY COUNTY STATE ZIP CODE
14188 N.57TH STREET BOX 2007 OAK PARK WASHINGTON IN 55082
NAME OF INSURANCE CO. POLICY NUMBER HOME TELEPHONE NG
► LMCIT CMC 18745
B ► IS THIS VEHICLE SUBJECT TO SECURITY AGREEMENT(S)?
FIRST SECURED PARTY(PRINT NAME) YES NO F YES,COMPLETE SECTION BELOW.
TE OF LOAN FOR ADDITIONAL SECURED PARTIES,
PURCHASER(S) ATTACH COMPLETED FORM NO.PS2017.
OWNER(S) STREET ADDRESS CITY STATE ZIP CODE
MUST
COMPLETE
C MILES(NO TENTHS) ODOMETER STATEMENT AND ASSIGNMENT BY SELLER (SEE WARNING ON BACK OF LAST PAGE)
► I(WE)THE OWNER(S)OF THE VEHICLE DESCRIBED ABOVE,CERTIFY THE ODOMETER ON THE VEHICLE NOW READS THE MILES AS SHOWN ON THE LEFT
AND THAT TO THE BEST OF MY(OUR)KNOWLEDGE THAT IT REFLECTS THE ACTUAL MILEAGE OF THE VEHICLE DESCRIBED ABOVE UNLESS ONE OF THE
SELLER(S) 10 FOLLOWING STATEMENTS IS CHECKED.I(WE)THE OWNER(S)OF THIS VEHICLE CERTIFY THE VEHICLE IS FREE OF ALL SECURITY INTERESTS,WARRANT
MUST TITLE,ASSIGN THE VEHICLE AND TAXES PAID TO THE PERSON(S)NAMED ABOVE.
COMPLETE ❑ (T)I HEREBY CERTIFY TO THE BEST OF MY KNOWLEDGE THE ODOMETER READING REFLECTS THE AMOUNT OF MILEAGE IN EXCESS OF ITS MECHANICAL LIMITS.
AND
SIGN ❑ (2)I HEREBY CERTIFY THAT THE ODOMETER READING IS NOT THE ACTUAL MILEAGE.WARNING—ODOMETER DISCREPANCY IF BOX(1)OR(4)IS CHECKED.
► DAMAGE DISCLOSURE STATEMENT. TO THE BEST OF MY KNOWLEDGE THIS VEHICLE ❑ HAS [j AS NOT(CHECK ONE)SUSTAINED DAMAGE IN EXCESS OF 70%ACTUAL CASH VALUE.
► POLLUTION SYSTEM DISCLOSURE STATEMENT. TO THE BEST OF MY KNOWLEDGE THE POLLUTION CONTROL SYSTEM ON THIS VEHICLE INCLUDING THE RESTRICTED GASOLINE PIPE
0 HAS HAS NOT(CHECK ONE)BEEN REMOVED,ALTERED OR RENDERED INOPERATIVE.
II.
SE6FSPRINTILmmI0EMEtS) COMPANY - TE
HIGHWAY 212 EAST DAWSON, MN 56232 STATE ZIPSELLER'S STREE 'ESS --».,a CITY
X4 41 ...1116
SELLER'S SIGNA E'
PURCHASER'S MOTOR VEHICLE SALESTAX DECLARATION BASE VALUE OR REGISTRATION TAX + $ c—¢ e. 4) c\
D $ ¢n GROSS WGHT PLATE FEE !�
1. FULL PURCHASE PRICE 3951 8.00 / /�
PURCHASER(S) REGISTRATION PERIOD ARREARS TAX
2 LESS TRADE-IN ALLOWANCE , ;,../y
OWNER(S) COMPLETE ITEM NO.6 FROM . �/ !j� JJ//TO -^^I fj !V) CONVERSION FEE
MUST �^ CHANGE OF GROSS VEHIi:L'i WEIGHT L
COMPLETE 3. NET PURCHASE PRICE 3951 8.00 TIME of
AND CHANGE ••
HOURS STATE PATROL VEHICLE FEE e....71 )
SIGN a %OF LEE 3 .
5. LESS TAX PAIDTO ANOTHER STATE 2568.67 DATE OF TRANSFER TAX
NET SALES TAX DUE $ ¢ CHANGE I I TITLE/TRANSFER FEE (-L
a.TRADE-IN WAS A: MAKE PLATE NUMBER DATE EXCISE TAX t'.--% f. - -7
MODEL YEAR .r-
EXPIRES I I LATE TRANSFER PENALTY _
N/A CHANGE OF WGT.AND/OR CLASS SUB-TOTAL$ C
PROM TO
I DECLARE L'NSR STATE/DEPUTY FILING FEE ; (.7'7'
THIS TAX I(WE)CERTIFY I(WE)AM(ARE)OF LEGAL AGE.HAVE BOUGHT TNS VEHICLE Q'
EXEMPTION CODE SUBJECT TO UENS SHOWN AND NO OTHERS,THIS VEHICLE B AND WILL TOTAL DUE$
COMMIE TO BE INSURED WHBE OPERATING UPON THE PUMK STREETS
NOTARY SIGNATURE SUBSCRIBED AND SWORN TO BEFORE ME DATE AND IIGIIWAYS.THE VEHICLE WLL BE OPERATED N COMPLIANCE WITH .7THE LAWS WHICH APPLY TO ITS CLASS OF REGISTRATION,NAVE RECEDE ' 1
A COPY OF THIS APPLICATION AND ALL Of MY(OLD)DECLARATIONS
�9, Ze
ARE
CLULVEEHE IACNLED H CIWERECAVIE PWKNIOBWEGRE COSATTMO NISA COGMA-
TONS LE TO COMMSCLUVEHICLE OPERATION,MINPESOTA STAT-
COUNTY DATE MY COMMISSION EXPIRES UTS,CHAPTER 221.PUBLIC SERVICE COMMISSION UES 1 THROUGH At
AND CODE OF FEDERAL REGULATIONS.ME 49.PARTS 39090THROUGH
OUGH
399.AND F A TRANSPORTER OF HAZARDOUS MATERIALS,CODE OF FEDERAL err-
REGULATIONS.TITLE 49,PARTS 171 TO 199.
tops MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES DIVISION P.S.2000 2000-19 SIGNATURE(S)(ALL PURCHASERS OWNERS(S)MUST SIGN) DATE
DO NOT SIGN UNTIL COMPLETED
HRDYYDN.,se'RMRo.RK 445 MINNESOTA ST.,SUITE 100,ST.PAUL,MN 55101. (612)296-6911 PURCHASER'S(OWNER'S COPY)
TTY/TDD#(612)297-2100